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Risk stratification for adults infected with SARS-CoV-2 COVID-19 continues to be essential to inform decisions about individual patients and allocation of resources and treatment options. Accurate knowledge of individual risk of severe COVID-19 can make an important contribution to healthcare both on a population and a personal level. There are currently few tools and solutions that help medical professionals to predict the evolution of SARS-COV-2 infected patients. So far, risk models for severe COVID-19 outcomes have included age and clinical comorbidities. The first wave of the COVID-19 pandemic spread rapidly in Spain, one of Europe’s most affected countries. In this retrospective study we analyzed genotypic and phenotypic data from 659 patients in the Basque region of Spain during the first wave of COVID-19, and compared mild with severe COVID-19 cases. Using genetic variants data as well as clinical variables of the participants we built a prediction model of severe COVID-19. We obtained robust results in the training data set with 85% sensitivity, 67% specificity and an Area Under the Curve (AUC) of 0.78. In the validation set the AUC was 0.75. The main advantage of our model is that because it includes genetic variants it could be used with medical records to identify the critical population in advance.

Context Familial neurohypophyseal diabetes insipidus is a rare disease produced by a deficiency in the secretion of antidiuretic hormone and is caused by mutations in the arginine vasopressin gene. Objective Clinical, biochemical, and genetic characterization of a group of patients clinically diagnosed with familial neurohypophyseal diabetes insipidus, 1 of the largest cohorts of patients with protein neurophysin II (AVP-NPII) gene alterations studied so far. Design The AVP-NPII gene was screened for mutations by PCR followed by direct Sanger sequencing in 15 different unrelated families from Spain. Results The 15 probands presented with polyuria and polydipsia as the most important symptoms at the time of diagnosis. In these patients, the disease was diagnosed at a median of 6 years of age. We observed 11 likely pathogenic variants. Importantly, 4 of the AVP-NPII variants were novel (p.(Tyr21Cys), p.(Gly45Ser), p.(Cys75Tyr), p.(Gly88Cys)). Conclusions Cytotoxicity seems to be due to consequences common to all the variants found in our cohort, which are not able to fold correctly and pass the quality control of the ER. In concordance, we found autosomal dominant familial neurohypophyseal diabetes insipidus in the 15 families studied.

The aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11-9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age >60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC=0.899, 95%CI: 0.846-0.953, p=0.942), which suggests the need for early intervention before the onset of prediabetes This work was partially supported by grants from the Department of Health of the Basque Country Government (2015111020); ISCIII (PI14/01104), co-funded by ERDF/ESF, "A way to make Europe"/"Investing in your future"; UPV/EHU (IT1281-19); Menarini Group Spain (BCA16/029); Endocrine-European Reference Network (EndoERN 739527); and CIBERDEM (Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders). The study funders were not involved in the design of the study; the collection, analysis, and interpretation of data; writing the report; and did not impose any restrictions regarding the publication of the report.

CIBERDEM (Ministerio de Economia, Industria y Competitividad-ISCIII), Ministerio de Sanidad, Servicios Sociales e Igualdad-ISCIII, Instituto de Salud Carlos III [PI14/00710, PI14/01104, PI14/00970, PI14/00874, PIE14/00031], Cuesta, M., Fuentes, M., Rubio, M., Bordiu, E., Barabash, A., Garcia De La Torre, N., Rojo-Martinez, G., Valdes, S., Soriguer, F., Vendrell, J.J., Urrutia, I.M., Ortega, E., Montanya, E., Menendez, E., Lago-Sampedro, A., Gomis, R., Goday, A., Castell, C., Badia-Guillen, R., Girbés, J., Gaztambide, S., Franch-Nadal, J., Delgado Álvarez, E., Chaves, F.J., Castano, L., Calle-Pascual, A.L.

Summary Familial hypocalciuric hypercalcemia type I is an autosomal dominant disorder caused by heterozygous loss-of-function mutations in the CASR gene and is characterized by moderately elevated serum calcium concentrations, low urinary calcium excretion and inappropriately normal or mildly elevated parathyroid hormone (PTH) concentrations. We performed a clinical and genetic characterization of one patient suspected of familial hypocalciuric hypercalcemia type I. Patient presented persistent hypercalcemia with normal PTH and 25-hydroxyvitamin D levels. The CASR was screened for mutations by PCR followed by direct Sanger sequencing and, in order to detect large deletions or duplications, multiplex ligation-dependent probe amplification (MLPA) was used. One large deletion of 973 nucleotides in heterozygous state (c.1733-255_2450del) was detected. This is the first large deletion detected by the MLPA technique in the CASR gene. Learning points: Molecular studies are important to confirm the differential diagnosis of FHH from primary hyperparathyroidism. Large deletions or duplications in the CASR gene can be detected by the MLPA technique. Understanding the functional impact of the mutations is critical for leading pharmacological research and could facilitate the therapy of patients.

The maintenance of magnesium (Mg2+) homeostasis is essential for human life. The Cystathionine-beta-synthase (CBS)-pair domain divalent metal cation transport mediators (CNNMs) have been described to be involved in maintaining Mg2+ homeostasis. Among these CNNMs, CNNM2 is expressed in the basolateral membrane of the kidney tubules where it is involved in Mg2+ reabsorption. A total of four patients, two of them with a suspected disorder of calcium metabolism, and two patients with a clinical diagnosis of primary tubulopathy were screened for mutations by Next-Generation Sequencing (NGS). We found one novel likely pathogenic variant in the heterozygous state (c.2384C>A; p.(Ser795*)) in theCNNM2gene in a family with a suspected disorder of calcium metabolism. In this family, hypomagnesemia was indirectly discovered. Moreover, we observed three novel variants of uncertain significance in heterozygous state in the other three patients (c.557G>C; p.(Ser186Thr), c.778A>T; p.(Ile260Phe), and c.1003G>A; p.(Asp335Asn)). Our study shows the utility of Next-Generation Sequencing in unravelling the genetic origin of rare diseases. In clinical practice, serum Mg2+ should be determined in calcium and PTH-related disorders. This study was supported by three grants from the Department of Health (2017111014, 2018111097 and 2019111052) and one grant from the Department of Education (IT1281-19) of the Basque Government. This work is generated within the Endocrine European Reference Network (Project ID number of Endo-ERN: 739527). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Our aim was to determine the incidence of type 2 diabetes mellitus in a nation-wide population based cohort from Spain (di@bet.es study). The target was the Spanish population. In total 5072 people older than 18 years,were randomly selected from all over Spain). Socio-demographic and clinical data, survey on habits (physical activity and food consumption) and weight, height, waist, hip and blood pressure were recorder. A fasting blood draw and an oral glucose tolerance test were performed. Determinations of serum glucose were made. In the follow-up the same variables were collected and HbA1c was determined. A total of 2408 subjects participated in the follow-up. In total, 154 people developed diabetes (6.4% cumulative incidence in 7.5 years of follow-up). The incidence of diabetes adjusted for the structure of age and sex of the Spanish population was 11.6 cases/1000 person-years (IC95% = 11.1–12.1). The incidence of known diabetes was 3.7 cases/1000 person-years (IC95% = 2.8–4.6). The main risk factors for developing diabetes were the presence of prediabetes in cross-sectional study, age, male sex, obesity, central obesity, increase in weight, and family history of diabetes. This work provides data about population-based incidence rates of diabetes and associated risk factors in a nation-wide cohort of Spanish population.

Objective To analyze the reference range of thyroid-stimulating hormone (TSH) in different BMI categories and its impact on the classification of hypothyroidism. Methods The study included 3,928 individuals free of thyroid disease (without previous thyroid disease, no interfering medications, TSH

Background: The aim of this study was to investigate the national prevalence of thyroid dysfunction in Spain and its association with various clinical, environmental, and demographic variables. Methods: The study included 4554 subjects (42.4% men) with a mean age of 50 years (range 18-93 years), who were participants in a national, cross-sectional, population-based survey conducted in 2009-2010. Data gathered included clinical and demographic characteristics, physical examination, and blood sampling. Thyrotropin, free thyroxine, free triiodothyronine, and thyroid peroxidase antibody (TPOAb) concentrations were analyzed by electrochemiluminescence. Urinary iodine (UI) levels were measured in an isolated urine sample. Results: The prevalence of treated hypothyroidism, untreated subclinical hypothyroidism, and untreated clinical hypothyroidism was 4.2% [confidence interval (CI) 3.6-4.9%], 4.6% [CI 4.0-5.2%], and 0.3% [CI 0.1-0.5%], respectively. The prevalence of total hypothyroidism (including all fractions) was 9.1% [CI 8.2-10.0%]. The prevalence of total hyperthyroidism was 0.8% [CI 0.6-1.1]. A total of 7.5% [CI 6.7-8.3%] of the population tested positive for TPOAbs (>= 50 IU/mL). In multivariate logistic regression models, TPOAbs were strongly associated with both hypothyroidism (p < 0.001) and hyperthyroidism (p = 0.005), whereas high UI levels (> 200 mu g/g creatinine) were associated with hypothyroidism (p < 0.001). The positive association between UI and hypothyroidism remained for both treated (p < 0.001) and untreated (p < 0.05) hypothyroidism, whereas it was especially significant for non-autoimmune (TPOAbs negative) forms (p < 0.001). At UI levels >= 200 mu g/g, there was a positive correlation between UI and thyrotropin levels (beta = 0.152, p < 0.001) and a negative correlation between UI and free triiodothyronine levels (beta=-0.134, p = 0.001). Conclusion: According to the data, a large proportion (10%) of the Spanish population has some evidence of thyroid dysfunction. High TPOAb concentrations were associated with both hypo- and hyperthyroidism, whereas high UI concentrations were associated with hypothyroidism.

Neonatal diabetes mellitus (NDM) is a rare form of diabetes diagnosed within the first 6 months of life. Genetic studies have allowed the identification of several genes linked to the development of NDM; however, genetic causes for ∼20% of the cases remain to be clarified. Most cases of NDM involve isolated diabetes, but sometimes NDM appears in association with other pathological conditions, including autoimmune diseases. Recent reports have linked activating mutations in STAT3 with early-onset autoimmune disorders that include diabetes of autoimmune origin, but the functional impact of STAT3-activating mutations have not been characterized at the pancreatic β-cell level. By using whole-exome sequencing, we identified a novel missense mutation in the binding domain of the STAT3 protein in a patient with NDM. The functional analyses showed that the mutation results in an aberrant activation of STAT3, leading to deleterious downstream effects in pancreatic β-cells. The identified mutation leads to hyperinhibition of the transcription factor Isl-1 and, consequently, to a decrease in insulin expression. These findings represent the first functional indication of a direct link between an NDM-linked activating mutation in STAT3 and pancreatic β-cell dysfunction.

It is well-known that feeling to be a healthy or sick person most probably results from the mind than from the body. We all know healthy people who feel sick and vice versa. We were interested in the health and sickness feeling of celiac people, their autorating of these feelings and its conditioning factors as well as their expectations. In this paper we present the results of an inquiry to evaluate these situations. We performed a descriptive, transversal and prospective study for 2 years to groups of celiacs and their families. They received a closed inquiry to be completed before the beginning of the talk. The inquiry included personal data and the co-existence of associated or concomitant (AoC) diseases. Most of the sample’s patients felt to be a healthy person (86.8%). Mothers see their children as healthy and the auto rated criteria is significantly better than the adult celiac person (“t”= -6.024 (p = 0.000)). AoC diseases influenced negatively in the feeling of being healthy and strongly decreased the autorating. Longer time passed on treatment reflects an increase feeling of health and of the autorating. In people with AoC diseases and who feel sick, the increased time of treatment did not show significant differences. People with “gluten sensitivity” felt sicker and auto rated themselves with a lower number than celiacs. Many pediatric gastroenterologists notice that the newly agreed definition of celiac disease, referring it as “autoimmune, chronic, incurable, and multisystemic”, results in a very negative character of the condition which might compromise the future labour of this people as well as their admittance to different health insurance systems.

Resumen Introduccion y objetivos El Di@bet.es es un estudio nacional disenado con el objetivo de estimar la prevalencia de diabetes mellitus y otros factores de riesgo cardiovascular en la poblacion adulta espanola. Se presenta la prevalencia de hipertension arterial y en que grado se reconoce, se trata y se controla. Metodos Se incluye una muestra de la poblacion espanola con 5.048 adultos de edad ≥ 18 anos. Se realizo un interrogatorio clinico y una exploracion que incluyo 3 lecturas de presion arterial en reposo y sedestacion para calcular la media de las 3 lecturas. Se definio hipertension como presion arterial sistolica ≥ 140 mmHg y/o presion arterial diastolica ≥ 90 mmHg y/o en tratamiento farmacologico antihipertensivo. Resultados El 42,6% de la poblacion adulta espanola de edad ≥ 18 anos es hipertensa, mas los varones (49,9%) que las mujeres (37,1%). La prevalencia fue superior entre los prediabeticos (67,9%) y diabeticos (79,4%). El 37,4% de los hipertensos estan sin diagnosticar, mas los varones (43,3%) que las mujeres (31,5%). Toman tratamiento farmacologico el 88,3% de los hipertensos conocidos y solo el 30% tiene la presion arterial controlada, mas las mujeres (24,9%) que los varones (16%). Conclusiones La prevalencia de hipertension en Espana es alta y un importante porcentaje de pacientes hipertensos aun estan sin diagnosticar. La hipertension se asocio con diabetes y prediabetes, y aunque el tratamiento farmacologico es cada vez mas frecuente, no logra mejorar el grado de control, que continua siendo bajo. Es importante desarrollar y promocionar campanas poblacionales de prevencion, deteccion y tratamiento de la hipertension arterial.

Introduction: Humans have gone through physical changes over the last 4 million years. The mouth, however, has not changed teeth quantity or quality. Eight incisors for fruits, vegetables and tubers; four little canines for little animals; eight premolars and twelve flat molars are used for crushing these foods, especially whole grains and legumes. The teeth crushing foods are the first step in the building of faecal matter. Foods are selected mostly according to cultural guidelines than to biological needs. The patterns of consumption are induced by the publicity of industrialized or processed foods. Material and Methods: This study design was observational, analytical, correlational, transversal and prospective. One thousand children (0 - 12 years old) were questioned in order to learn about the relationship between Weekly Eating Frequency (WEF) and Faecal Matter (FM) characteristics. The FM was classified as soft , normal or hard and the outcome was expressed as Dry Faecal Residue (DFR). The WEF and Weekly Bowel Movement Frequency (WBMF) were determined and tabulated according to times per week. Environmental factors, parents’ education level and children’s birth order were examined. Results: There was a strong association between DFR, WBMF and WEF. Environment and education level did not play a key role although birth order did matter. Conclusions: Fibre-free foods (dairies, meats, flours and sweeties or sodas) increased DFR. Foods containing fibre from vegetables decreased DFR, which in turn contributed to the WBMF. Lowest DFR was observed in children under Exclusive Breastfeeding (EB). Distant last-born children had higher DFR. Comments: Daily examples support these results and it is clear that children’s FM is built by their parents. We encourage parents to follow the “mouth nature” rather than the “advertisements nature”., Facultad de Ciencias Médicas (FCM)

El tabaquismo es considerado la principal causa de muerte prevenible en el mundo. La mayoría de los fumadores inician esta adicción durante edades tempranas, especialmente, durante la adolescencia. El objetivo del estudio fue identificar los determinantes de consumo adolescente y evaluar el impacto de una intervención educativa en la prevalencia del tabaquismo. Métodos. Estudio antes-después controlado, realizado durante los años 2010-2012 en dos colegios secundarios de la ciudad de La Plata. En ambos, se realizó una encuesta basal seguida de dos mediciones posteriores; en uno de ellos, se implementó una intervención educativa dirigida a jóvenes de 12 y 13 años. Se utilizaron modelos de regresión múltiple para identificar las variables asociadas al tabaquismo y evaluar el impacto de la intervención. Resultados. Se incluyeron 1911 encuestas (Colegio A: 617; Colegio B: 1294). Las variables asociadas al tabaquismo adolescente fueron la tenencia de un hermano fumador (odds ratio –OR– 2,55), madre fumadora (OR 2,32), años de edad (OR 1,92) y el sexo femenino (OR 1,75). El OR ajustado por dichos determinantes para ser fumador actual en el colegio intervención versus el control fue 0,54 (intervalo de confianza –IC– del 95%: 0,35-0,83) en el primer año de seguimiento y 0,98 (IC 95%: 0,60-1,61) en el segundo año. Conclusiones. La tenencia de una madre o un hermano fumador, la edad y el sexo femenino se correlacionaron fuertemente con el consumo de cigarrillos. La intervención educativa tuvo un efecto positivo en el primer año de seguimiento, pero luego no se mantuvo., Facultad de Ciencias Médicas

Te study was supported by CIBER in Diabetes and Associated Metabolic Disorders - CIBERDEM (ISCIII - Ministerio de Ciencia e Innovación), Ministerio de Sanidad y Consumo, Spanish Society of Diabetes – SED, Consejería de Salud Junta de Andalucía “Andalucía se mueve con Europa” (0256/2007), Instituto de Salud Carlos III and FEDER “Una manera de hacer Europa” (PI11/02755, PI14/00710, PI14/01104, PI14/00970, PI14/00874 and PI14/00465), Sociedad Andaluza de Endocrinología, Diabetes y Nutrición (Beca SAEDYN)., Maldonado-Araque, C., Valdés, S., Lago-Sampedro, A., Lillo-Muñoz, J.A., Garcia-Fuentes, E., Perez-Valero, V., Gutierrez-Repiso, C., Goday, A., Urrutia, I., Peláez, L., Calle-Pascual, A., Castaño, L., Castell, C., Delgado, E., Menendez, E., Franch-Nadal, J., Gaztambide, S., Girbés, J., Ortega, E., Vendrell, J., Chacón, M.R., Chaves, F.J., Soriguer, F., Rojo-Martínez, G.

Smoking is considered the main cause of preventable death worldwide. Most smokers start using tobacco at an early age, especially during adolescence. The objective of this study was to identify the determinants of adolescent use of tobacco and assess the impact of an educational intervention on the prevalence of smoking. Methods. Controlled, before and after study conducted between 2010 and 2012 at two secondary schools in the city of La Plata. A baseline survey was administered at both schools followed by two subsequent measurements; an educational intervention aimed at youth aged 12 and 13 years was implemented in one of the schools. Multiple regression models were used to identify the outcome measures associated with smoking and assess the impact of the intervention. Results. A total of 1911 surveys were included (school A: 617; school B: 1294). The outcome measures associated with adolescent smoking were having a sibling who smokes (odds ratio [OR]: 2.55), a mother who smokes (OR: 2.32), age (OR: 1.92), and female sex (OR: 1.75). The OR adjusted for these determinants to be a current smoker at the intervention school versus the control school was 0.54 (95% confidence interval [CI]: 0.35-0.83) in the first year of follow-up and 0.98 (95% CI: 0.60-1.61) in the second year. Conclusions. Having a mother or a sibling who smokes, age, and female sex were strongly correlated to cigarette smoking. The educational intervention had a positive effect in the first year of follow-up, which was not maintained over time., Facultad de Ciencias Médicas

Objective The aim of this study was to examine possible associations between ambient temperature and obesity in the Spanish population using an ecological focus. Methods The Di@bet.es study is a national, cross-sectional, population-based survey of cardiometabolic risk factors and their association with lifestyle. Sample: 5,061 subjects in 100 clusters. Variables: Clinical, demographic and lifestyle survey, physical examination, and blood sampling. The mean annual temperature (°C) for each study site was collected from the Spanish National Meteorology Agency (1971-2000). Results The prevalence rates of obesity in the different geographical areas divided according to mean annual temperature quartiles were 26.9% in quartile 1 (10.4-14.5°C), 30.5% in quartile 2 (14.5-15.5°C), 32% in quartile 3 (15.5-17.8°C), and 33.6% in quartile 4 (17.8-21.3°C) (P = 0.003). Logistic regression analyses including multiple socio-demographic (age, gender, educational level, marital status) and lifestyle (physical activity, Mediterranean diet score, smoking) variables showed that, as compared with quartile 1, the odd ratios for obesity were 1.20 (1.01-1.42), 1.35 (1.12-1.61), and 1.38 (1.14-1.67) in quartiles 2, 3, and 4, respectively (P = 0.001 for difference, P

Introduction Dyslipidemia is a significant contributor to the elevated CVD risk observed in type 2 diabetes mellitus. We assessed the prevalence of dyslipidemia and its association with glucose metabolism status in a representative sample of the adult population in Spain and the percentage of subjects at guideline-recommended LDL-C goals. Material and methods The di@bet.es study is a national, cross-sectional population-based survey of 5728 adults. Results A total of 4776 subjects were studied. Dyslipidemia was diagnosed in 56.8% of subjects; only 13.2% of subjects were treated with lipid lowering drugs. Lipid abnormalities were found in 56.8% of Spanish adults: 23.3% with high LDL-C, 21.5% high TG, 35.8% high non-HDL-C, and 17.2% low HDL-C. Most normal subjects showed an LDL-C ≤ 3.36 mmol/l. Pre-diabetics presented similar proportion when considering a goal of 3.36 mmol/l, but only 35% of them reached an LDL-C goal ≤ 2.6 mmol/l. Finally, 45.3% of diabetics had an LDL-C ≤ 2.6 mmol/l, and only 11.3% achieved an LDL-C ≤ 1.8 mmol/l. Conclusions Our study demonstrates a high prevalence of dyslipidemia in the adult Spanish population, and a low use of lipid-lowering drugs. Moreover, the number of subjects achieving their corresponding LDL-C goal is small, particularly in subjects at high cardiovascular risk, such as diabetics.

Introduction and objectives To assess the patterns of use of 8 therapeutic drug groups for the treatment of diabetes mellitus and other cardiovascular risk factors, and to identify sociodemographic and health determinants of their use in the overall Spanish population. Methods A representative sample of the Spanish population within the Di@bet.es study, a cross-sectional population-based survey, was included. Study variables: sociodemographic, clinical, and lifestyle data; physical examination, and an oral glucose tolerance test in patients without known diabetes mellitus. Furthermore, patients were systematically queried about current medication use, and 8 pharmacotherapeutic groups were evaluated: lipid-lowering therapy, antihypertensives, oral hypoglycemic agents, insulin, thyroid hormone, uricosurics, psychoactive drugs, and nonsteroidal anti-inflammatory drugs. Results Sixty-six percent of the Spanish population was taking at least one medication. Therapeutic drug use was associated with age, independently of the higher prevalence of diabetes mellitus, hypertension, or hyperlipidemia in older patients. Sex disparities were found in the use of lipid-lowering agents, allopurinol, levothyroxine, nonsteroidal anti-inflammatory drugs, and psychoactive drugs. Use of psychoactive drugs was related to education level, work status, physical activity, smoking, and alcohol consumption. Almost 30% of patients with diabetes mellitus were taking 6 or more medications daily. Diabetes mellitus was associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs. Conclusions Age and sex are the most important factors determining therapeutic drug use. Lifestyle patterns and sociocultural factors have an impact only on psychoactive drug use. Diabetes mellitus is associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs.

Resumen Introduccion y objetivos Evaluar el patron de consumo de ocho grupos de farmacos para el tratamiento de la diabetes mellitus y otros factores de riesgo cardiovascular; identificar en la poblacion espanola los determinantes sociodemograficos y de salud asociados al consumo de aquellos. Metodos El estudio Di@bet.es es una encuesta poblacional transversal que comprende una muestra significativa de la poblacion adulta espanola. Variables de estudio: datos sociodemograficos, clinicos y de estilo de vida; exploracion fisica, y sobrecarga oral de glucosa. Ademas, se pregunto sistematicamente la medicacion consumida y se analizaron ocho grupos de farmacos: hipolipemiantes, antihipertensivos, antidiabeticos orales, insulina, hormona tiroidea, uricosuricos, psicofarmacos y antiinflamatorios no esteroideos. Resultados El 66% de la poblacion toma alguno de los farmacos estudiados. El consumo de dichos medicamentos se asocia con la edad, independientemente de la prevalencia de diabetes mellitus, hipertension o dislipemia. Se han encontrado diferencias significativas entre sexos en el consumo de hipolipemiantes, hormona tiroidea, uricosuricos, antiinflamatorios no esteroideos y psicofarmacos. El consumo de psicofarmacos se asocio significativamente con nivel educativo, situacion laboral, actividad fisica y consumo de tabaco y alcohol. El 30% de los sujetos con diabetes mellitus tomo mas de seis farmacos diarios. La diabetes mellitus se asocio significativamente con un mayor consumo de antihipertensivos, hipolipemiantes y antiinflamatorios no esteroideos. Conclusiones La edad y el sexo son los factores mas importantes que determinan el consumo de farmacos. El estilo de vida y el nivel sociocultural afectan solo al uso de psicofarmacos. La diabetes mellitus se asocia a un mayor consumo de antihipertensivos, hipolipemiantes y antiinflamatorios no esteroideos.

Background and Aims: Mediterranean diet (MedDiet) is causally related to diabetes and is a dietary pattern recommended to individuals with diabetes. We investigated MedDiet adherence in individuals with prediabetes and unknown (PREDM/UKDM) or known diabetes (KDM) compared to those with normal glucose metabolism (NORMAL). Methods: This was a national, population-based, cross-sectional, cluster-sampling study. MedDiet adherence was scored (MedScore, mean ± SD 24 ± 5) using a qualitative food frequency questionnaire. Logistic regression was used to examine the association between MedScore and PREDM/UKDM or KDM versus control subjects. Results: We evaluated 5,076 individuals. Mean age was 50 years, 57% were female, 826 (582/244) were PREDM/UKDM, 478 were KDM and 3,772 were NORMAL. Mean age increased across MedScore tertiles (46, 51 and 56 years, p < 0.0001). Higher age-adjusted adherence to MedDiet (5-unit increment in the MedScore) was associated with lower and nondifferent odds (OR, 95% CI) of prevalent PREDM/UKDM (0.88, 0.81-0.96, p = 0.001) and KDM (0.97, 0.87-1.07, p = 0.279), respectively, compared to individuals in the NORMAL group. Conclusions: In a representative sample of the whole Spanish population, MedDiet adherence is independently associated with PREDM/UKDM. Therapeutic intervention may be, in part, responsible for the lack of differences in adherence observed between the KDM and NORMAL groups. However, reverse causation bias cannot be ruled out in cross-sectional studies.

Neonatal diabetes mellitus (NDM) is a rare form of diabetes diagnosed within the first 6 months of life. Genetic studies have allowed the identification of several genes linked to the development of NDM; however, genetic causes for ∼20% of the cases remain to be clarified. Most cases of NDM involve isolated diabetes, but sometimes NDM appears in association with other pathological conditions, including autoimmune diseases. Recent reports have linked activating mutations in

Eur J Clin Invest 2012 Abstract Background Although high-sensitivity C-reactive protein (hs-CRP) is currently used as a risk marker of cardiovascular disease, it has been suggested that genetic, clinical, biochemical or environmental factors could modify hs-CRP levels. The aim of this study was to investigate sources of interindividual hs-CRP variability in the Spanish population. Materials and methods A representative sample of the Spanish population within the di@bet.es study was used. Study variables included a clinical and demographic structured survey, a lifestyle survey, a physical examination, plasmatic hs-CRP and other biochemical parameters. Results Median and interquartile range of plasma hs-CRP values were 1·73 ± 2·75 mg/dL. Thirty per cent of the study population had hs-CRP levels above 3 mg/dL and 38% from 1 to 3 mg/dL. Body mass index was the strongest factor associated with moderate and high hs-CRP levels. Age, sex, waist-to-hip ratio, weight increase, plasma lipid levels, glucose metabolism (HOMA-IR and abnormal glucose regulation categories), pharmacological treatment (lipid-lowering agents, psychotropic drugs and levothyroxine), smoking, physical activity, different dietary patterns, quality of life and educational level were all significantly associated with hs-CRP levels. Interactions were observed between variables. These interactions modulated the effect of previously described factors on hs-CRP. Conclusions Thirty per cent of the Spanish population have hs-CRP levels considered to represent a cardiovascular risk. Different clinical, anthropometric, biochemical and environmental variables modulate hs-CRP levels. In addition, multiple interactions between variables complicate the interpretation of hs-CRP values.

The effects of eight commonly used fungicides: propamocarb, fenarimol, triadimefon, procimidone, azoxystrobin, carbendazim, cooper oxychloride and Trichoderma harzianum on germination, mycelial growth and virulence of Isaria fumosorosea (Wize) Brown & Smith (Ascomycota: Hypocreales) was studied. The greatest effect on germination was observed by azoxystrobin, followed by carbendazim, triadimefon and procimidone. Propamocarb, fenarimol, cooper oxychloride and T. harzianum did not affect conidial germination with germinations of 95, 93, 79 and 84%, respectively. Virulence was evaluated against early fourth instar nymphs of Trialeurodes vaporariorum (Hemiptera: Aleyrodidae). The mix containing fungal conidial suspensions plus cooper oxychloride or fenarimol presented a significant reduction in the mortality in comparison with spore suspension itself. This study suggests that the most appropriate fungicides for use in Integrated Pest Management Programs against T. vaporariorum in combination with I. ...

Introduction and objectives Di@bet.es is a national study designed to estimate the prevalence of diabetes mellitus and other cardiovascular risk factors in the Spanish adult population. The prevalence of hypertension and the degree to which it is recognized, treated, and controlled are described. Methods The study included a sample of the Spanish population with 5048 adults aged ≥ 18 years. Patients were questioned and examined, with 3 blood pressure readings while seated and at rest to calculate the mean of the 3 readings. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or prescription for antihypertensive drug therapy. Results Hypertension was found in 42.6% of the Spanish adult population aged ≥ 18 years and was more common among men (49.9%) than women (37.1%). The prevalence was higher among prediabetics (67.9%) and diabetics (79.4%). Undiagnosed hypertension was identified in 37.4% of patients and was more common in men (43.3%) than in women (31.5%). Among patients with known hypertension, 88.3% were receiving drug therapy. Well-controlled blood pressure was found in only 30% and was more common among women (24.9%) than men (16%). Conclusions The prevalence of hypertension in Spain is high, and a considerable percentage of hypertensive patients have still not been diagnosed. Hypertension is associated with diabetes and prediabetes, and although drug therapy is increasingly common, the degree of control has not improved and remains low. Population campaigns should be developed and promoted for hypertension prevention, detection, and treatment.

This study is composed of 506 nonpatient adults, ages 18 to 65, all from Argentina. The data were gathered by five examiners, who tested most of the participants at their work site. Inclusion and exclusion criteria are described and interrater reliability statistics at the response level are presented along with findings for the Rorschach Comprehensive System (CS; Exner, 1994).

Little progress been made in elucidating the transmission pathway of the invertebrate iridescent virus (MIV). It has been proposed that the MIV has no active means to enter the mosquito larva. We have previously found that the presence of the mermithid nematode Strelkovimermis spiculatus is associated with MIV infection in Culex pipiens under field conditions. In the present study, we evaluated the transmission of MIV to C. pipiens larvae mediated by S. spiculatus and several factors involved in this pathway (mosquito instars, nematode:mosquito larva ratio, amount of viral inoculum). Our results indicate that S. spiculatus functions as an MIV vector to C. pipiens larvae and seems to be an important pathway of virus entry into this system. Moreover, TEM images of S. spiculatus exposed to the viral suspension showed no infections inside the nematode but showed that viral particles are carried over the cuticle of this mermithid. This explains the correspondence between MIV infection and the factors that affect the parasitism of S. spiculatus in C. pipiens larvae. Fil: Muttis, Evangelina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Centro de Estudios Parasitológicos y de Vectores (i); Argentina Fil: Micieli, Maria Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Centro de Estudios Parasitológicos y de Vectores (i); Argentina Fil: Urrutia, María Inés. Universidad Nacional de La Plata. Centro Superior para el Procesamiento de la Información; Argentina Fil: García, Juan José. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Centro de Estudios Parasitológicos y de Vectores (i); Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentina

The effect of two propagation methods (use of stolons in winter and shoots in spring) on the yield of fresh and dried leaves of peppermint (Mentha Xpiperita L.) was studied in a field experiment in the La Plata zone of Argentina. Fresh and dry weights were greater for plants propagated from stolons in winter and harvested in summer (in full bloom and post-bloom) and from shoots planted in spring if plants were harvested post-bloom.

El objetivo del trabajo fue comparar el grado de compromiso cardíaco entre dos poblaciones de chagásicos, con residencia permanente en área endémica y con exposición ocasional al parásito y con contagio por vía no vectorial (transfusional, connatal, y otras). Los resultados mostraron que los infectados ocasionales presentan menor presencia de cardiopatía; y cuando presentan cardiopatía, tienen menor prevalencia de miocardiopatía dilatada que los infectados con residencia permanente en el área endémica. También se plantea el rol del parásito, la cantidad de infecciones, los mecanismos inmuno-patogénicos desarrollados, la calidad de vida y el tipo de tareas laborales en la diferente evolución de estos pacientes.The aim of the study was to compare the degree of cardiac compromise between two patient groups infected with Chagas' disease, A) those permanently residing in endemic areas and B) those sporadically exposed to the parasite and indirectly (non-vector) infected (transfusion , mother-to-child transmission, etc.). The results show that patients sporadically infected presented a lower prevalence of cardiopathy, and when they do present cardiopathy, there is a lower prevalence of dilation when compared to infected patients residing in endemic areas. Also, the role of the parasite, number of reinfections, immunopathogenic mechanisms, quality of life and occupation are considered in the study of disease progression in each patient.

El objetivo del trabajo fue comparar el grado de compromiso cardíaco entre dos poblaciones de chagásicos, con residencia permanente en área endémica y con exposición ocasional al parásito y con contagio por vía no vectorial (transfusional, connatal, y otras). Los resultados mostraron que los infectados ocasionales presentan menor presencia de cardiopatía; y cuando presentan cardiopatía, tienen menor prevalencia de miocardiopatía dilatada que los infectados con residencia permanente en el área endémica. También se plantea el rol del parásito, la cantidad de infecciones, los mecanismos inmuno-patogénicos desarrollados, la calidad de vida y el tipo de tareas laborales en la diferente evolución de estos pacientes.

Fossil and living shells of Littoridina australis (d’Orbigny, 1835) (Mesogastropoda, Hydrobiidae) from the marine Holocene in the Bonaerensian coastal area (Argentina) and the modern SW Atlantic littoral zone (southern Brazil, Uruguay, Argentina) document its wide intraspecific morphological variability and offer implications for the interpretation of paleoenvironmental changes that have occurred since about 7.6 ka BP. Shell morphs previously described as different taxa, i.e. L. australis , Littoridina isabelleana (d’Orb.), Littoridina australis crassa (Gaillard), Littoridina conexa (Gaillard), Littoridina parchappii (d’Orb.), can be linked together in a chain of transitional forms that reflect responses or adaptations to different salinity conditions. A biometrical study of L. australis allows independent testing of the hypothesis of a polymorphic species ranging from medium-sized chubby shells (= L. conexa ) (oligomesohaline environments, 3–18‰) to a smaller elongate morph (= L. isabelleana ) (polyeuhaline habitats, 18–35‰) with the predominant bigger morph (= L. australis lectotype; = L. crassa ) (genuine brackish species in typically mesohaline waters, 8–18‰) in the middle of the morphological gradient. Results of the covariance analysis applied to 10 fossil and eight modern sample groups indicate: (1) no significant discrepancies between L. australis vs. L. crassa , L. australis vs. L. conexa or L. australis vs. L. isabelleana ; (2) significant differences between L. conexa vs. L. isabelleana ; (3) highly significant differences between L. australis and L. parchappii ; (4) slight differences between L. conexa and L. parchappii . Together with paleoecological data and geographical distribution, these results suggest that: (1) L. parchappii represents a separate species; (2) ‘ conexa ’, ‘ isabelleana ’ and ‘ crassa ’ are intraspecific variations (ecomorphs) of L. australis ; (3) ‘ conexa ’ is intermediate between both species; (4) during the time span of the Holocene transgression (ca. 7.6–1.4 ka BP) only two species lived in the area: L. parchappii in oligohaline waters and L. australis with its optimum in brackish (mixohaline) conditions and ecomorphic variations within the estuarine environment; (5) the modern restriction of L. australis is a consequence of salinity changes linked to sea-level fluctuations along the Bonaerensian littoral.

The authors have performed 1500 surveys on the subject of acceptability of the celiac condition, based on a questionnaire on the frequency of various claims by the celiac community. The questionnaire design resulted from previous meetings in which the authors participated as guest experts. The authors intended to characterize the subjective reactions of the attendants to said meetings. With that in mind, an investigation was made on the age, gender, educational level, number of celiac relatives, time and degree of adherence to the gluten-free diet, clinical features at the beginning of treatment, what issues patients find to be troublesome in every-day life, their wishes when confronted with this peculiar condition, their fantasies and their realistic expectations. It was found that most of the participants were female and that educational level has a positive impact regarding a complete adherence to the diet. The number of persons with CD in the same family conspires against diet adherence and the most important social issue was not having restaurants with a gluten-free menu. It was also discovered that the attendants’ hoped-for solution was a cure and that their realistic expectation was to have safe, palatable and affordable food throughout the whole country as well as a law that took notice of their condition. When the 1306 surveys on the Impact of Diagnosis were analyzed, it was found that the exact words used by the physician and the patient's level of education do not play a key role in the time it takes to accept the celiac condition. In addition, it became clear that the words used by the physician have different effects when first heard by an adult with celiac disease and when first heard by a mother of children with celiac disease. These words, according to the authors' analyses, contribute to heighten emotions in patient support groups but definitely hinder the acceptance process.

Background and aim Prevalence rates of "metabolically healthy obese" (MHO) subjects vary depending on the criteria used. This study examined the prevalence and characteristics of MHO subjects and metabolically abnormal normal-weight subjects and compared the findings with the NHANES 1999–2004 study. The aims of the present study were, first, to determine the prevalence rates of MHO and MNHNO subjects using the same criteria as those of the National Health and Nutrition Examination Survey (NHANES) (1999–2004) study, and second to compare the prevalence and correlates of obese subjects who are resistant to the development of adiposity-associated cardiometabolic abnormalities (CA) and normal-weight individuals who display cardiometabolic risk factor clustering between the Spanish and the US populations. Methods and results Di@bet.es study is a national, cross-sectional population-based survey of 5728 adults conducted in 2009–2010. Clinical, metabolic, sociodemographic, and anthropometric data and information about lifestyle habits, such as physical activity, smoking habit, alcohol intake and food consumption, were collected. Subjects were classified according to their body mass index (BMI) (normal-weight, 2 ; overweight, 25–29.9 kg/m 2 ; and obese, >30 kg/m 2 ). CA included elevated blood pressure; elevated levels of triglycerides, fasting glucose, and high-sensitivity C-reactive protein (hs-CRP); and elevated homeostasis model assessment of insulin resistance (HOMA-IR) value and low high-density lipoprotein cholesterol (HDL-c) level. Two phenotypes were defined: metabolically healthy phenotype (0-1 CA) and metabolically abnormal phenotype (≥2 CA). The prevalence of metabolically abnormal normal-weight phenotype was slightly lower in the Spanish population (6.5% vs. 8.1%). The prevalence of metabolically healthy overweight and MHO subjects was 20.9% and 7.0%, respectively, while in NHANES study it was 17.9% and 9.7%, respectively. Cigarette smoking was associated with CA in each phenotype, while moderate physical activity and moderate alcohol intake were associated with being metabolically healthy. Olive oil intake was negatively associated with the prevalence of CA. Conclusions Smoking, physical activity level, and alcohol intake contribute to the explanation of the prevalence of CA in the Spanish population, as in the US population. However in Spain, olive oil intake contributes significantly to the explanation of the variance in the prevalence of CA.

Hemos realizados 1500 encuestas de “Aceptabilidad de la condicion celiaca” donde puntualizamos la incidencia de los distintos reclamos de la comunidad escuchados en las reuniones previas en las que participabamos invitados como expertos. Quisimos saber quienes y como eran los que concurrian y para ellos averiguamos sexo, edad, instruccion, cantidad de celiacos en el hogar, y anos que llevaban haciendo la dieta, el nivel de cumplimiento, con que cuadro clinico habian iniciado el tratamiento, que cosas le fastidiaban de la vida cotidiana, cuales eran sus deseos frente a esta singular dolencia, sus fantasias y su expectativa real. Comprobamos que la poblacion que concurria era substancialmente femenina y el impacto positivo de la instruccion en el cumplimiento de la dieta. Descubrimos que la cantidad de celiacos en una misma familia conspira con el adecuado cumplimiento de la dieta. Los problemas sociales que mas le desagradaban, destacandose el hecho de no disponer de menues seguros en Restaurantes. Supimos que la fantasia era “un remedio que los cure” y que la expectativa real era “una ley” que los contemple. Cuando analizamos las 1306 encuestas del “Impacto de diagnosticos” vimos que las palabras utilizadas por el medico y la instruccion del paciente no juega un rol importante en tiempo que insume aceptar la celiaquia y que las palabras utilizadas por el medico impactan de un modo en el adulto celiaco de otro modo en la madre del nino celiaco, que esta palabras favorecen las sensaciones en los grupos de autoayuda pero entorpecen la aceptacion.

10.1007/s00592-013-0468-8 The aim of the study is to assess the prevalence of metabolic syndrome (MetS) in Spain using specific cutoff points for waist circumference (WC) (>94.5 cm for men and >89.5 cm for women) and evaluating the influence of several socio-demographic and economic factors. Data on MetS were obtained from a national study of 4,727 subjects from 18 to 90 years of age, conducted in Spain between 2009 and 2010 (The di@bet.es study). MetS was defined applying the new Harmonized definition (evaluating the use of abdominal obesity (AO) as a obligatory criterion for MetS or not) as well as with other widely used criteria. Results were then compared with data from previous studies. Multiple logistic regression models were used to evaluate the influence of different social factors. The age-standardized MetS prevalence was 38.37 % (CI 35.74¿40.99) in men and 29.62 % (CI 27.56¿31.69) in women, when AO was required as a diagnostic criterion; 42.13 % (CI 39.37¿44.89) and 32.31 % (CI 30.15¿34.47) in men and women, respectively, if AO was not considered mandatory. Prevalence of MetS increased with age (p < 0.001 for trend). Women with a lower educational level were more likely to have MetS (OR 4.4; 95 % CI: 2.84-6.7) as compared with those with a higher educational level. Subjects with MetS had a worse physical quality of life. The combination of AO, hypertension and carbohydrate alterations was the most common MetS¿ pattern. A high prevalence of MetS was detected in the Spanish population especially in men, the elderly and women with a low educational level.

Scenedesmus obliquus cells were immobilized by adsorption in preformed polyurethane and polyvinyl foams as well as by entrapment using urethane prepolymer. Adsorption on polymeric foams appeared to be the most convenient immobilization method, mainly when cells were initially adsorbed in a nitrogen-free medium. Nitrogen starvation of cells appeared to enhance their adsorption to the polymeric foams. The net O 2 evolution activity and nitrate removal capacity of free-living and polyvinyl-adsorbed cells were similar, indicating that immobilization did not significantly affect the physiology of microalgae. The N removal capacity of polyvinyl-adsorbed cells was studied in batch and in a lab-scale continuous-flow bioreactor. Nitrogen starvation greatly increased the N uptake rate of immobilized cells. The effects of illumination (intensity and photoperiod), residence time, and CO 2 supply were investigated with respect to the N removal efficiency of the bioreactor. It was concluded that S. obliquus cells adsorbed in hydrophilic, commercially available polymeric foams are of potential value for biologic N depollution of drinking waters contaminated with nitrogenous fertilizers.

Although high-sensitivity C-reactive protein (hs-CRP) is currently used as a risk marker of cardiovascular disease, it has been suggested that genetic, clinical, biochemical or environmental factors could modify hs-CRP levels. The aim of this study was to investigate sources of interindividual hs-CRP variability in the Spanish population.A representative sample of the Spanish population within the di@bet.es study was used. Study variables included a clinical and demographic structured survey, a lifestyle survey, a physical examination, plasmatic hs-CRP and other biochemical parameters.Median and interquartile range of plasma hs-CRP values were 1·73 ± 2·75 mg/dL. Thirty per cent of the study population had hs-CRP levels above 3 mg/dL and 38% from 1 to 3 mg/dL. Body mass index was the strongest factor associated with moderate and high hs-CRP levels. Age, sex, waist-to-hip ratio, weight increase, plasma lipid levels, glucose metabolism (HOMA-IR and abnormal glucose regulation categories), pharmacological treatment (lipid-lowering agents, psychotropic drugs and levothyroxine), smoking, physical activity, different dietary patterns, quality of life and educational level were all significantly associated with hs-CRP levels. Interactions were observed between variables. These interactions modulated the effect of previously described factors on hs-CRP.Thirty per cent of the Spanish population have hs-CRP levels considered to represent a cardiovascular risk. Different clinical, anthropometric, biochemical and environmental variables modulate hs-CRP levels. In addition, multiple interactions between variables complicate the interpretation of hs-CRP values.